AMT

Patient Estimated Amount Due

Pos: 175	Max: 1
Detail - Optional
Loop: 2300	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

AMT01

522

Amount Qualifier Code
Description: Code to qualify amount

M

ID

1/3

Required

Code

Name

F3

Patient Responsibility - Estimated

Description: Approximate value one receiving medical care is obliged to pay

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Patient Responsibility Amount
UB-92 Ref. [UB-Name]: 55, Patient Line [Estimated Amount Due]
EMC v.6.0 Reference: Record Type 20 Field No. 24

M

R

1/18

Required

Notes:

1. The amounts in this segment at the claim level Loop ID-2300 apply to all service lines unless overridden in the AMT segment in Loop ID-2400. An amount is considered to be overridden if the value in AMT01 is the same in both the claim level AMT segment and the service line level AMT segment.
2. This segment is required when the Patient Responsibility Amount is applicable to this claim.

Example:

AMT*F3*123~